WHO recommendations on antenatal care for a positive pregnancy experience

Executive summary
Introduction
In 2016, at the start of the Sustainable Development Goals (SDGs) era, pregnancy-related preventable morbidity
and mortality remains unacceptably high. While substantial progress has been made, countries need to
consolidate and increase these advances, and to expand their agendas to go beyond survival, with a view to
maximizing the health and potential of their populations.
The World Health Organization (<strong>WHO</strong>) envisions a world where every pregnant woman and newborn receives
quality care throughout the pregnancy, childbirth and the postnatal period. Within the continuum of reproductive
health care, antenatal care (ANC) provides a platform for important health-care functions, including health
promotion, screening and diagnosis, and disease prevention. It has been established that by implementing timely
and appropriate evidence-based practices, ANC can save lives. Crucially, ANC also provides the opportunity to
communicate with and support women, families and communities at a critical time in the course of a woman’s
life. The process of developing these <strong>recommendations</strong> on ANC has highlighted the importance of providing
effective communication about physiological, biomedical, behavioural and sociocultural issues, and effective
support, including social, cultural, emotional and psychological support, to pregnant women in a respectful way.
These communication and support functions of ANC are key, not only to saving lives, but to improving lives,
health-care utilization and quality of care. Women’s positive experiences during ANC and childbirth can create
the foundations for healthy motherhood.
This is a comprehensive <strong>WHO</strong> guideline on routine ANC for pregnant women and adolescent girls. The aim is
for these <strong>recommendations</strong> to complement existing <strong>WHO</strong> guidelines on the management of specific pregnancyrelated
complications. The guidance is intended to reflect and respond to the complex nature of the issues
surrounding the practice and delivery of ANC, and to prioritize person-centred health and well-being – not only
the prevention of death and morbidity – in accordance with a human rights-based approach.
The scope of this guideline was informed by a systematic review of women’s views, which shows that women
want a positive pregnancy experience from ANC. A positive pregnancy experience is defined as maintaining
physical and sociocultural normality, maintaining a healthy pregnancy for mother and baby (including preventing
or treating risks, illness and death), having an effective transition to positive labour and birth, and achieving
positive motherhood (including maternal self-esteem, competence and autonomy).
Recognizing that a woman’s experience of care is key to transforming ANC and creating thriving families and
communities, this guideline addresses the following questions:
• nWhat are the evidence-based practices during ANC that improve outcomes and lead to a positive pregnancy
experience?
• nHow should these practices be delivered?
Guideline development methods
These ANC <strong>recommendations</strong> are intended to inform the development of relevant health-care policies and
clinical protocols. The guideline was developed using standard operating procedures in accordance with the
process described in the <strong>WHO</strong> handbook for guideline development. Briefly, these procedures include:
(i) identification of priority questions and outcomes; (ii) evidence retrieval and synthesis; (iii) assessment of
the evidence; (iv) formulation of the <strong>recommendations</strong>; and (v) planning for implementation, dissemination,
impact evaluation and updating of the guideline. The quality of the scientific evidence underpinning the
<strong>recommendations</strong> was graded using the Grading of Recommendations Assessment, Development and
Executive summary
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